Respiratory Epithelial Adenomatoid Hamartoma is Frequent in Olfactory Cleft After Nasalization

Abstract

ObjectivesTo assess the site and histopathology of polyps at the first revision surgery for recurrent nasal polyposis (NP) after radical ethmoidectomy (nasalization).Study DesignRetrospective study.MethodsBetween January 2008 and December 2015, a total of 62 patients having undergone revision surgery for recurrent NP after nasalization were included. The site and histology of the recurrence of polyps were analyzed according to operative and pathological reports.ResultsHistology showed classical inflammatory nasal polyps (CINP) in 91% of nasal cavities at primary surgery versus respiratory epithelial adenomatoid hamartoma (REAH) or REAH associated to CINP in 54.8% at revision surgery (P < .0001). Polyps were principally observed in the ethmoidal complex in 70% of nasal cavities during primary surgery and in the olfactory clefts in 88.7% during revision surgery (P < .0001). The mean interval between nasalization and first revision surgery was 8.8 ± 4.4 years (0.4–21.7 years). This interval was significantly shorter for grade 3 polyps, polyps removed from both ethmoidal complex and olfactory cleft at primary surgery, association of CINP and REAH at primary surgery, and when primary surgery had preserved the middle turbinates.ConclusionPolyp recurrences after nasalization were mainly observed in the olfactory clefts and can be different histological features: inflammatory polyps, respiratory epithelial adenomatoid hamartoma, or a combination of both.Level of Evidence4 Laryngoscope, 130:2098–2104, 2020

Predictors and prognosis of respiratory epithelial adenomatoid hamartoma in sinonasal cavities

“…As for recurrence of REAH, it was reported that 15 of 363 (4%) patients had recurrence of REAH, and all of them required reoperation 6 . Another study demonstrated REAH in 8.9% of nasal cavities at primary surgery versus REAH in 54.8% at revision surgery, meaning that REAH is found more frequently at revision surgery 30 . In our study, postoperative mucosal thickening and polyp recurrence were more likely to occur in the REAH group.…”

“… 6 Another study demonstrated REAH in 8.9% of nasal cavities at primary surgery versus REAH in 54.8% at revision surgery, meaning that REAH is found more frequently at revision surgery. 30 In our study, postoperative mucosal thickening and polyp recurrence were more likely to occur in the REAH group. However, no reoperation cases have been diagnosed with REAH, and no REAH cases have yet required reoperation.…”

Is Respiratory Epithelial Adenomatoid Hamartoma Related to Central Compartment Atopic Disease?

“…Patients with isolated- and associated-REAH also differed in the rate of prior ESS, a factor that has been linked with OC opacification and REAH development. 23–25 Overall, 53.8% of patients in this study underwent ESS prior to identification of REAH. Patients with isolated-REAH had lower rates of prior ESS (25%) compared to those with associated-REAH (66.7%).…”

Predictive significance of computed tomography in bilateral sinonasal respiratory epithelial adenomatoid hamartoma

“…REAH can exist in isolation or association with other inflammatory processes, with nasal polyps (NP) being the most frequent 5,7 . In previous reports, REAH is found in about 30% to 55% of patients who undergo primary or revision surgery for NP 3,8–10 . In addition, REAH and CRSwNP are easily confused in terms of symptoms.…”